食管癌术后早期肠内营养的临床应用

目的: 探讨食管癌术后早期进行肠内营养的安全性、可行性和临床效果。方法: 选取80例食管癌手术患者,随机分为肠内营养组(EN组,n=42)和肠外营养组(PN组,n=38)。所有病例在术前和术后第7天各测定一次血清总蛋白、白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数、尿素氮、肌酐、血糖和丙氨酸氨基转换酶,临床观察营养支持后有无消化道症状、胃肠功能恢复情况、术后并发症及住院时间等指标。结果: 所有病例在研究期间无死亡、无明显肝肾功能改变。营养支持后EN组前白蛋白、转铁蛋白和淋巴细胞计数水平明显升高(P<0.01),营养支持后EN组与PN组相比,白蛋白、前白蛋白、转铁蛋白和淋巴细胞计数水平明显增高(P<0.001),临床观察EN组早期下床活动时间及肛门恢复排气时间较PN组均显著缩短(P<0.001),EN组住院时间明显减少(P<0.01),且无严重术后并发症发生。结论: 食管癌术后早期肠内营养支持是安全可行的,是一种较肠外营养更有效的营养方式,它能明显改善机体的营养状态,恢复机体的免疫功能,减少术后并发症的发生。

Early enteral nutrition in postoperative patients with esophageal cancer

Objective:To explore the feasibility,safety and clinical effects of early postoperative enteral nutrition(EN) for patients with esophageal cancer.Methods:Eighty cases of esophageal cancer were randomly divided into EN group( n =42) and parenteral nutrition(PN) group( n =38).A series of parameters including serum total proteins,serum albumin,prealbumin,transferrin,lymphocyte count,urea nitrogen,creatinine,serum glucose and glutamic pyruvic transaminase were tested preoperatively and at postoperative day 7.The sympotom of digestive tract,resumption of gastrointestinal functions,postoperative complication and length of hospital stay were carefully observed and recorded.Results:No mortality occurred during the period of study.There was no evidence of damage of EN to the renal or liver function.The concentration of prealbumin,transferrin and lymphocyte count was significantly elevated after nutritional support in EN group( P <0.01).Compared with PN group,the concentration of serum albumin,prealbumin,transferrin and lymphocyte count was significantly increased after nutritional support in EN group( P <0.01).The early out of bed activity and the bowel movement resumed significantly earlier in EN group than those in PN group( P <0.001).The length of hospital stay was shorter in EN group( P <0.01) and there was no serious complication in EN group.Conclusions:Early postoperative enteral nutrition for patients with esophageal cancer is safe,feasible and effective.The early enteral nutrition is beneficial to the improvement of nutritional status,resumption of immunological function,reduction of the postoperative complication and improvement of the quality of life.